Patient Suffers Cardiac Arrest During Pain Management Procedure

This case involves a middle-aged male patient with a history of persistent back and shoulder pain who went in for a lumbar facet rhizotomy. The patient had previously undergone several facet joint injections but was otherwise healthy. The patient was administered the anesthesia and his vital signs were stable for the first 15 minutes of the procedure. His vitals were not taken again. 8 minutes later, the patient was found to be in cardiac arrest. However, the physician opted to continue the procedure for another 12 minutes before intubating the patient. In spite of intubation, the patient ultimately passed away due to oxygen deficiency secondary to airway obstruction. An expert in pain management was sought to review the records and opine on the standard of care in this case.

Question(s) For Expert Witness

1. How often do you perform lumbar facet rhizotomy procedures?

2. At what point in time after the procedure is it reasonable to stop recording vital signs?

Expert Witness Response E-024812

I am double board certified in pain medicine and anesthesiology. I am in full-time clinical practice, as the director of pain management for a community hospital in the northeast. I typically perform approximately 40 interventional pain management procedures weekly, including lumbar facet procedures (i.e. diagnostic blocks and rhizotomy). I perform lumbar facet rhizotomy procedures (also called lumbar facet radiofrequency ablation) approximately 4- 5 times per week as a part of my routine clinical practice.The frequency of vital signs recording would depend upon multiple factors, including the type of procedure being performed, whether or not sedation is utilized, the physical condition of the patient, and patient comorbidities, among other factors. As a matter of standard practice, vital signs should be recorded at baseline (before the procedure), during the procedure at an appropriate interval (as determined by the nature of the procedure, +/- sedation), and after the procedure until the patient is deemed suitable for discharge. Even after a patient is assessed as being recovered from anesthesia, it would be incumbent on providers and medical staff to ensure patient wellbeing until the time of discharge.